Hawaii's successful system for providing health care at relatively inexpensive rates has been replicated in many states and may be a partial model for nationwide health care reform. The rise in the number of workers laid off from jobs that included health insurance shows the need to extend employer-based insurance to universal coverage.

Hawaii became the first state to require minimum mandatory employer-based health insurance 35 years ago. As a result, a study released this week by the Robert Wood Johnson Foundation showed that one in seven adult workers in Hawaii are uninsured, compared with one in five nationally.

Meanwhile, a study by the Dartmouth Institute last month showed that the national average cost of Medicare, which covers the elderly and disabled, was $8,304 in 2006, while the cost in Hawaii was $5,311, lowest in the nation. Some attribute that to systems like Kaiser Permanente, a health plan that directly employs doctors. Still, small businesses in Hawaii complain about the rising cost of providing health benefits to employees.

During last year's presidential campaign, then- candidate Barack Obama proposed requiring most companies to offer their employees health insurance or pay a payroll tax of 7 percent into a pool financing government-sponsored insurance. The president now says he doesn't “;presume that it was a perfect plan or that it was the best possible plan.”;

The number of uninsured Americans has reached 46 million, and there is talk of expanding Medicare, a step toward a government-run system that some fear would come close to nationalizing the health care industry.

Republican Senate leaders have warned Obama in a letter that “;forcing free-market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition,”; resulting in “;a single government-run program controlling all of the market.”; Private insurers maintain they can guarantee affordable, adequate health coverage without resorting to a government plan.

Obama has become flexible about what health care reform should include and he has solicited leaders of labor unions, business groups, hospitals, insurance companies and consumer organizations to engage in discussion. That contrasts with the approach of the Clinton administration, which unloaded on Congress a comprehensive, detailed reform measure that sank on arrival.

Health care reform should not be put off because of the current economic crisis, which has thrown millions of families into their own crises by the loss of health insurance because of job losses. Obama's proposed expenditures of at least $634 billion — it could be much more — on reform over 10 years is needed to assist those families and create universal health care for the future.